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Moore M, Levitt S, Lin CC, Wolfe I, Alaia E, Meislin R, Strauss EJ, Jazrawi L, Alaia MJ, Kaplan D. Clinical outcomes following transtibial medial meniscal root repair are maintained at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38923098 DOI: 10.1002/ksa.12321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To evaluate long-term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to identify patient surgical and magnetic resonance imaging (MRI) characteristics associated with improved outcomes. METHODS This was a single-centre, retrospective study evaluating patients who had undergone a PMMR repair using a transtibial suture pullout technique with two locking cinch sutures. This was performed as a follow-up to previously published 2-year and 5-year outcome studies, using the same cohort. All patients from the prior short-term and midterm studies were invited to participate. Patient-reported outcome (PROs) scores, including the International Knee Documentation Committee (IKDC) and Lysholm scores, were collected. Previously collected demographic data were updated based on review of the electronic medical record. Patient outcomes were assessed preoperatively, as well as at 2-year, 5-year and 8-year postoperatively. MRI outcome measurements were assessed at 2-year and 5-year follow-ups. All statistical analysis was performed using SPSS version 26. RESULTS Seventeen patients of the original 18 patients (94.4%) were included in the final analysis. Additionally, three patients who had additional ipsilateral surgery were excluded from the analysis of PROs. The IKDC score significantly increased from 44.7 ± 11.6 at preoperative baseline to 71.2 ± 21.3 at 8-year post-operation (p = 0.001). There were no significant differences in IKDC score between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). The Lysholm score significantly increased from 49.6 ± 7.3 at preoperative baseline to 76.4 ± 17.2 at 8-year follow-up (p < 0.001). There was no significant difference in Lysholm scores between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). A linear regression analysis found that 5-year IKDC scores were significantly correlated with 8-year IKDC scores (β = 0.681, p = 0.038). At 8-year follow-up, four (23.5%) patients required additional procedures on their operative knee (one total knee arthroplasty conversion). CONCLUSION Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long-term follow-up despite worsening MRI outcomes at short-term and medium-term follow-ups. While a high proportion of patients required additional procedures on their operative knee at 8-year follow-up, few of these patient's additional procedures were related to failure of their primary surgery. Providers and patients may expect durable clinical outcomes following the repair of PMMRT, irrespective of radiographic appearance. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Michael Moore
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Sarah Levitt
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Charles C Lin
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Isabel Wolfe
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Erin Alaia
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Robert Meislin
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel Kaplan
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B, Al-Khelaifi K. Meniscus root tears: state of the art. INTERNATIONAL ORTHOPAEDICS 2024; 48:955-964. [PMID: 38261073 PMCID: PMC10933189 DOI: 10.1007/s00264-024-06092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Meniscus root tears represent significant pathology that, historically, has been underdiagnosed and undertreated. However, the recognition of their clinical and functional significance has recently surged, mainly due to their frequent association with anterior cruciate ligament injuries. AIM This comprehensive review discusses various aspects of meniscal root tears, including their epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management and surgical techniques.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | | | | | | | - Bruno Olory
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Manatrakul R, Loeffler M, Bharadwaj UU, Joseph GB, Lansdown D, Feeley B, Baal JD, Guimaraes JB, Link TM. Clinical and radiologic outcomes in patients with meniscal root tears. BMC Musculoskelet Disord 2024; 25:232. [PMID: 38521904 PMCID: PMC10960405 DOI: 10.1186/s12891-024-07359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS Ninety patients were included. VAS pain scores were significantly (p < 0.01) lower after arthroscopic repair compared to conservative treatment (1.27±0.38vs.4±0.52) at the last follow-up visit with median (IQR) of 325 (180-1391) days. Increased meniscal extrusion (mm) was associated with higher odds of receiving non-surgical treatment (OR = 1.65, 95%CI 1.02-2.69, p = 0.04). The odds of having arthroscopic repair increased by 19% for every 1 mm increase in the distance of the tear from the root attachment (OR = 1.19, 95% CI: 1.05-1.36, p < 0.01). The odds of undergoing arthroscopic repair were reduced by 49% for every 1 mm increase in the extent of meniscal extrusion (OR = 0.51, 95% CI: 0.29-0.91, p = 0.02) as observed in the baseline MRI. CONCLUSIONS Patients who underwent arthroscopic repair had lower pain scores than patients with conservative treatment in the follow-up. Distance of the torn meniscus to the root attachment and the extent of meniscal extrusion were significant predictors for arthroscopic repair in the next three weeks (time from the baseline MRI to the surgery date).
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Affiliation(s)
- Rawee Manatrakul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Maximilian Loeffler
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Upasana U Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Julio B Guimaraes
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
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Migliorini F, Schäfer L, Bell A, Weber CD, Vecchio G, Maffulli N. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5485-5495. [PMID: 37812251 PMCID: PMC10719156 DOI: 10.1007/s00167-023-07600-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography. METHODS This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Two reviewers independently performed the analysis and a methodological quality assessment of the included studies. All the clinical investigations which compared repair versus resection of meniscal tears were accessed. RESULTS Data from 20 studies (31,783 patients) were collected. The mean BMI was 28.28 ± 3.2 kg/m2, and the mean age was 37.6 ± 14.0 years. The mean time elapsed from injury to surgery was 12.1 ± 10.2 months and the mean medial joint width was 4.9 ± 0.8 mm. Between studies comparability at baseline was found in age, women, BMI, time from injury to surgery and length of the follow-up, PROMs, medial joint width, and stage of OA. The resection group demonstrated a greater Lysholm score (P = 0.02). No difference was found in the International Knee Documentation Committee (P = 0.2). Nine studies reported data on the rate of failures at a mean of 63.00 ± 24.7 months. No difference was found between the two groups in terms of persistent meniscal symptoms (P = 0.8). Six studies reported data on the rate of progression to total knee arthroplasty at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to knee arthroplasty (P = 0.0001). Six studies reported data on the rate of advanced knee OA at a mean of 48.0 ± 14.7 months of follow-up. The repair group evidenced a lower rate of advanced knee OA (P = 0.0001). No difference was found in the mean joint space width (P = 0.09). CONCLUSION Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy. No difference in PROMs, medial joint width, and failures were evidenced. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Christian David Weber
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | - Nicola Maffulli
- Faculty of Medicine and Psychology, University Hospital Sant' Andrea, University La Sapienza, 00185, Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, UK
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Compagnoni R, Ferrua P, Minoli C, Fajury R, Ravaglia R, Menon A, Randelli PS. The meniscal extrusion index is a reliable indirect sign of different meniscal lesion patterns: a classification based on percentage of meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 2023; 31:5005-5011. [PMID: 37653144 PMCID: PMC10598112 DOI: 10.1007/s00167-023-07525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This study's goal is to propose a straightforward classification system based on the MEI (Meniscal Extrusion Index), a measure of meniscal extrusion, that relates to various meniscal lesion patterns and has clinical and biomechanical significance. The study's secondary goal is to determine whether the standard 3 mm meniscal extrusion parameter still has value by correlating the MEI with it. METHODS 1350 knee MRIs that were performed over the course of 2 years made up the study cohort. Following the application of inclusion and exclusion criteria, 200 of those patients were qualified to participate in the study. All the measurements examined for this study underwent an interobserver reliability test. RESULTS In the 1350 MRIs that were examined for this study, meniscal extrusion of any grade was present 18.9% of the time. The use of the MEI revealed three groups of patients: those with a MEI < 20%, who are likely para-physiological; those with a MEY between 20% and 40%, who are in a grey area; and those with a MEY > 40%, who have lesions that are impairing the proper meniscal function. According to the authors' findings, the percentage of meniscal extrusion did not correlate with the finite number (3 mm), making the 3 mm parameter an unreliable evaluation method. CONCLUSIONS This study is clinically relevant, because it proposes a simple and reproducible classification of meniscal extrusion that may aid in evaluating the severity of an extrusion and help in the diagnosis of lesions that might be difficult to identify on MRI. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo Compagnoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via della Commenda, 10, 20122, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Paolo Ferrua
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Carlo Minoli
- U.O.C. Week Surgery, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
- Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Raschid Fajury
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Rossella Ravaglia
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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Choi BS, Chung J, Kwak J, Han HS. Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4492-4500. [PMID: 37195475 DOI: 10.1007/s00167-023-07444-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for osteoarthritis (OA) progression and clinical failure. METHODS A prospectively collected database was retrospectively reviewed for patients who were diagnosed with acute medial meniscus posterior root tear (MMPRT) between 2013 and 2021 and treated non-surgically for more than 2 years. Patient demographic characteristics and clinical outcomes including pain numeric rating scale (NRS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee radiographs were obtained to assess the angle of knee alignment and Kellgren-Lawrence (K-L) grade during the first and annually follow-up visits. Baseline magnetic resonance (MR) images were reviewed for the presence of medial meniscus extrusion, bone marrow edema, subchondral insufficiency fracture of medial femoral condyle, and cartilage lesion. The OA progression group was defined as patients who experienced a worsening of one or more grades in the K-L classification system. Prognostic factors were evaluated for OA progression and conversion to total knee arthroplasty (TKA). RESULTS Ninety-four patients (90 female and 4 male) with a mean age of 67.0 ± 7.3 years (range, 53-83 years) were followed for a mean of 46.1 ± 22.1 months (range, 24.1-170.5). During the follow-up period, no significant differences in clinical scores were observed, and there were also no significant differences between the groups with and without OA progression. Overall, 12 patients (13%) underwent TKA at a mean of 20.7 ± 16.5 months (range, 8-69 months) and 34 patients (36%) demonstrated OA progression at a mean time of 24 ± 15 months (range, 12-62). The subchondral insufficiency fracture was a prognostic factor for OA progression (p = 0.045 for knee radiograph and p = 0.019 for MR) and conversion to TKA (RR, 4.08 [95% CI 1.23-13.57]; p = 0.022). CONCLUSIONS Non-surgical treatment for acute medial meniscus posterior root tear did not result in any significant change in clinical outcomes from the initial to the final follow-up. The rate of conversion to arthroplasty was 13%, and the rate of osteoarthritis progression was 36%. Furthermore, subchondral insufficiency fracture was found to be a concomitant prognostic factor correlated with OA progression and conversion to arthroplasty. This information can provide insights for physicians when discussing treatment options with patients, particularly regarding the use of non-surgical treatment and may contribute as a source for future studies of medial meniscus posterior root tear. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Byung Sun Choi
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jeehyeok Chung
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Junpyo Kwak
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Oladeji LO, Reynolds G, Nuelle CW, DeFroda SF. Securing the Root: Meniscus Root Repair with Rip Stop and Cannulated Drilling. Arthrosc Tech 2023; 12:e1665-e1672. [PMID: 37942109 PMCID: PMC10627872 DOI: 10.1016/j.eats.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion of meniscal root. These injuries are important to recognize because they contribute to impaired joint mechanics and rapid articular cartilage degeneration. Given this, there remains significant interest in identifying novel surgical techniques that may facilitate better surgical repair and enhance patient outcomes. The purpose of this technical note is to describe a surgical technique for a medial meniscus root ripstop repair with cannulated drilling. This technique is simple and reproducible, while also allowing for the augmentation of potentially poor tissue quality.
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Affiliation(s)
- Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
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Barnes RH, Hobayan CGP, Cavendish PA, Milliron EM, Flanigan DC. Posterior Meniscal Root Repair With Transtibial Double Tunnel Pullout Technique and Anchor Fixation. Arthrosc Tech 2023; 12:e1133-e1138. [PMID: 37533914 PMCID: PMC10390842 DOI: 10.1016/j.eats.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
Meniscus root tears are tears that occur within 1 cm of the meniscus root attachment to the tibia. If not repaired, root tears will lead to altered knee biomechanics and accelerated degenerative changes in the knee. In this surgical technique, we demonstrate repair of a meniscus root tear with an all-inside suture repair of the posterior meniscus that is then passed through 2 transtibial tunnels and then fixed with an anchor. After surgery, patients are non-weightbearing for 4 weeks and can return to activity by 6 months.
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Affiliation(s)
| | | | | | | | - David C. Flanigan
- Address correspondence to David C. Flanigan, Ohio State University Wexner Medical Center, Department of Orthopaedics, 2835 Fred Taylor Drive 2000, Columbus, OH 4321, U.S.A.
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Moon HS, Choi CH, Jung M, Chung K, Jung SH, Kim YH, Kim SH. Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1181. [PMID: 37511993 PMCID: PMC10386469 DOI: 10.3390/medicina59071181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author's treatment strategies.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Yun-Hyeok Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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10
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Khoo JR, Yau WP. Repair of meniscus root tear - Is there a difference between medial meniscus root repair and lateral meniscus root repair? A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231175233. [PMID: 37173149 DOI: 10.1177/10225536231175233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
PURPOSE Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature. METHODS Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest. RESULTS Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7 mm, which was significantly larger than the 0.9 ± 1.2 mm observed after LMPRT repair (p < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair (p < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair (p < 0.001). CONCLUSIONS LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.
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Affiliation(s)
- Jun Ren Khoo
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - W P Yau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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McKeithan LJ, Lameire DL, Tagliero AJ, Chahal J, Gwathmey FW, Lee CA. What's New in Sports Medicine. J Bone Joint Surg Am 2023; 105:582-590. [PMID: 36853964 DOI: 10.2106/jbjs.22.01385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Lydia J McKeithan
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, California
| | - Darius L Lameire
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam J Tagliero
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Cassandra A Lee
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, California
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Ma J, Liu X, Lu H, Zhang D, Zhao T, Wang J, Jin S. Effects of proprioceptive training in the recovery of patients submitted to meniscus surgery: systematic review and meta-analysis. BMJ Open 2022; 12:e055810. [PMID: 35680251 PMCID: PMC9185499 DOI: 10.1136/bmjopen-2021-055810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate the effects of proprioceptive training on rehabilitation of knee after arthroscopic partial meniscectomy (APM). DESIGN PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Technology Periodical Database, WanFang Data and China Biology Medicine were searched until December 2021 for randomised controlled trials. PARTICIPANTS Patients who have undergone APM for meniscus injury caused by traumatic tear. RESULTS A total of 9 studies with 453 patients were included in this study for meta-analysis, and 2/9 with high quality, 6/9 with moderate quality. Based on very low quality evidence, the pooled effect showed significant improvement for proprioceptive training group in proprioception test (p<0.05, I2=18%), knee extensor muscle strength (p<0.05, I2=29%), knee flexor muscle strength (p<0.05, I2=0%) and knee function score (p<0.05, I2=0%) compared with conventional training group in patients after APM. CONCLUSION Based on very low quality, adding proprioceptive training to conventional rehabilitation programmes might be beneficial to promote functional recovery for patients after APM. It is necessary to carry out more samples and higher quality large-scale studies to provide high evidence in the future. PROSPERO REGISTRATION NUMBER CRD42020213201.
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Affiliation(s)
- Jiang Ma
- Medical Rehabitation Department, Affiliated Sport Hospital Of Chengdu Sport University, Chengdu, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoxiao Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaimin Lu
- Medical Rehabitation Department, Affiliated Sport Hospital Of Chengdu Sport University, Chengdu, China
| | - Di Zhang
- Rehabitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tianyu Zhao
- Rehabitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ju Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song Jin
- Rehabitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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